The dirty-yellow brick road to ADRENAL FATIGUE…are you headed there??


STTM YELLOW BRICK ROAD(This page was first written in 2008 and has been updated to the present day and time. Enjoy!)

Do you ever feel like you want to strangle your doctor with your bare hands?

Of course, we don’t mean it literally, but there is heightened frustration about the lack of knowledge displayed by our doctors!

Today, I am once again appalled and saddened by the endless body of thyroid patients who continue to plummet into the abyss of adrenal fatigue/adrenal insufficiency, day after day after day. And it just never needs to happen if doctors would simply pay attention and be informed.

Belinda is the perfect example.

She didn’t participate in thyroid patient groups anymore, living her life happily, because she thought her post-RAI thyroid treatment was under control, being on 2 grains of Natural Desiccated Thyroid for a year and a “normal” TSH.

But suddenly, she felt the need to return to her groups and seek feedback. Because 2 grains was not an optimal dose for Belinda. She has become more irritable and moody, has a hard time falling asleep, and feels frequently anxietal. Labs are redone, and she finds herself with a slightly over-range free T3 and a very suppressed TSH. Her doctor decides to lower her thyroid meds, which in turn improves her insomnia and anxiety, but weight starts piling on. She’s confused and wonders how she can find her balance between being on too little with unwelcome weight gain and being on too much with uncomfortable anxiety and insomnia.

What Belinda didn’t get, and what her doctor didn’t get, is that Belinda had now joined the dubious camaraderie of those with adrenal fatigue/adrenal insufficiency–a needless condition of over-stressed and now under-functioning adrenals i.e. low cortisol. As a result, T3 in natural desiccated thyroid starts to pool in the blood, or raises the inactive Reverse T3, either causing anxiety, insomnia, and all sorts of low cortisol symptoms.

In Belinda’s case, the problem was that 2 grains was not an optimal dose for Brenda, even if her TSH looked oh-so-normal! Because it’s never about the TSH. It’s about where our free T3 falls and more.

Thyroid patients just like Belinda have to first discover what is going on, then face the complicated balancing act of treating adrenal fatigue AND hypothyroidism. And it’s a path that never needed to happen.


  1. Being undiagnosed, or being dosed by, the faulty TSH lab test and its dubious “normal” range, which will leave you with lingering hypothyroid symptoms.
  2. Being treated by T4-only medications like Synthroid, Levoxyl, Eltroxin, et al, which end up teasing your adrenals to work harder to take up the slack of an inadequate treatment, then to fall into the abyss of low cortisol.
  3. Lowering your expectations of what “normal” is. No, it’s not normal to have less stamina than others, to be on an anti-depressant to bandaid your hypo depression, to feel colder than others, to require frequent naps, to feel the need to avoid people, to be bothered by lights or noises, to be told by those you love that you are too defensive or over-reactive…and so on.

I hope anyone reading this comes to an understanding that you canNOT enter your doctor’s office as if you are entering the throne of a god. Your doctor, no matter how educated, dedicated or wonderful, may not have a strong understanding of the role of adrenal function in relationship to bad treatment via T4-only meds or the TSH lab range. You may have to bring this knowledge to your doctor, or find another one who is either learned, or open-minded. Because your chances of having adrenal fatigue/insufficiency are higher if you are on T4, if the TSH is worshipped by your doctor whether on T4 or desiccated thyroid, or if you keep walking into the doctor’s office and hang your own knowledge on the hook outside his or her door.




Order the STTM II book and read Chapter 15. It’s brilliantly written by an MD who gives a most excellent explanation of how we get there!




STTM graphic How cortisol can cause problems when raising NDT

Important notes: All the information on this website is copyrighted. STTM is an information-only site based on what many patients worldwide have reported in their treatment and wisdom over the years. This is not to be taken as personal medical advice, nor to replace a relationship with your doctor. By reading this information-only website, you take full responsibility for what you choose to do with this website's information or outcomes. See the Disclaimer and Terms of Use.

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25 Responses to “The dirty-yellow brick road to ADRENAL FATIGUE…are you headed there??”

  1. Donna

    My cortisol results:
    2.7 (3.7 – 9.5) L
    2.0 (1.2- 3.0) L
    1.0 ( .6 – 1.9)
    1.1 (.4 – 1.0) H
    Hashimoto’s with one half thyroid. LDN.
    My concern is that in about two months I have surgery. My doctor who is on good doctor list but has his faults acknowledges that I am not on enough NDT (2.5 grains) And the we need to do something about the adrenals.
    So he prescribed glandular and it wired me. I use Adrenal cortex 200mg (2 upon waking, 2 around 10 am, 1 around
    Should I use HC cream to get my adrenals ready before surgery? I am not satisfied with my doctor’s treatment; he wants to do something after surgery (HC or medrol). Finding a doctor who will even acknowledge adrenal fatigue is VERY
    difficult. I am on my own…which is scary and doesn’t help with stress.

    • Janie Bowthorpe

      Starting dose of 50 mg ACE (adrenal cortex) for women, when saliva results are low (and your afternoon is slightly low, too) is 3,2,1,1. i.e. 3 first thing, then 2 in four hours, then 1 in four hours, then 1 in four hours. Start doing one’s Daily Average Temps on the 6th – 10th day…we have to find our right amount. It’s all in chapter 6 of the revised STTM book, which mentions hydrocortisone but also applies to ACE.

  2. Amanda

    Hi all. Wow this read is fantastic. Very helpful. Could someone tell me, I’m using hc cream divided into doses, how long do you continue to do it. Is it until you get better or a certain length of time? Do I need to slowly reduce the dose. Thanks x

  3. Karin

    Hi all…
    On my saliva test my cortisol is low at all four times but the rhythm is good. I haven’t got hypothyroidism, if anything my tsh is low and t3 and t4 is on the high side…
    My DHEA is very high, as is my testosterone indicating that my acth is working but as my cortisol is low the negative feedback to slow down the acth production isn’t working, giving me high androgens but low cortisol..
    I’m considering the cream or even the oral hydrocortisone but will have to treat myself as the doctors in Sweden won’t take saliva test as valid..on the blood test my cortisol is within range…where would I start..? Would love some help!

    • Janie Bowthorpe

      Hi Karin. I want to make sure you understand that the low saliva results, in spite of what you call a good rhythm, is not a good thing. I think you do understand, but wanted to be sure. We have to have the right amount of cortisol for thyroid hormones to get to the cells well. As far as your high free’s, have you tested for Hashimoto’s with BOTH antibodies? Because those highs could be part of the hyper swing, and your thyroid is slowly being destroyed with Hashi’s. Also, high androgens could be this:

      • Karin

        Thank you…no pcos, been checked…
        I have a good dr, all tests are taken for the thyroid..he’s gonna do an ultrasound next..
        I really feel my problem is the low cortisol messing with my whole body..unfortunately the drs in Sweden don’t trust the saliva test and on blood my cortisol is within range…don’t know what to do..

  4. Jason

    I take Hydrocortisone (20mg morning, 1o mid day) I’m hypo- pituitary. Can I still suffer from adrenal fatigue even if my endo says I’m within range for my Cortisol? How can supplement cortisol possible mimic natural cortisol release. Why am I so tired all the time, why do I turn to food and over eat when my energy levels crash? Why when asked do I feel like I’m hypothyroid I reply by saying I don’t, how am I supposed to feel? Have I just adapted to feeling crap most of the time and think this is normal?, can I expect to feel better?


    • Janie Bowthorpe

      Hi Jason. I want to explain what we’ve learned over the years based on reading studies and our experiences, and let you decide. One, we never go that high (20 mg) with cortisol at any one time. We’ve seen that it shuts down our natural feedback loop too much. i.e. for men, 12.5 is the highest dose at any one time. I’m not sure if this is an issue for you since you have hypopituitary, but I do wonder if you are spreading the cortisol around enough during the day?? Maybe you can find out. Second, we dose 4 times a day to “imitate” the circadian rhythm. No, giving cortisol to ourselves can never replicate how the body does it, but we try our best.

      Next, we do Daily Average Temps to find our right amount. It’s explained really well in Chapter 6 of the revised STTM book if you have that.

      Finally, there are labs you can do to see if hypo (free T3 and free T4), but it’s NOT based on “falling in the normal range” and doctors simply don’t get this. Here’s the page that explains about lab results:

      Yes, we DO feel better again, but we have to become informed on how, which is with T3 in our treatment, knowing how to read labwork, and teaching our doctors. 🙂

  5. Mark

    Purple Moon and other posters,

    Pantothenic acid is much cheaper, though some people and doctors think pantathene is the better way to go. I’ve yet to find how much cortisol will be produced from, let’s say, 500 mg of pantothenic acid but I do feel it when I take it. (feel warmer, mood improves and have more energy) The downside is that if you take too much, you’ll get loose stools but I’ve taken several grams now and then during pollen season, since it helped my allergies, though I was on and off the toilet a bit, lol.

  6. Purple Moon

    Hi Lily, I totally agree w/ Janie and thank you both for keeping the thread going. The more information we have the better we can care for ourselves. Just like everyone here, I’ve been struggling for answers for a long time. I stumbled across Hyrdocortisone cream by accident. I starting having adrenal crisis about 4 years ago but have had this problem for 20 years. I do a lot of research and thru blood and saliva testing finally have my answer…problem is finding what “medicine” will work for you, when I was in my 20s I got really sick after taking an antibiotic and had a severe allergic reaction and now after putting the puzzle together realized my adrenals were drained, causing my thyroid to shut off (producing Reverse T3) and caused total insomnia, no intestinal function, and no menstrual cycle…never had a problem before this…I litterally felt like I was turned off as a person…trying to explain this to doctors got me no where….only the last few years after a lot research on hormones and testing…realized what had happended….cortisol is at the heart of all my problems. I also believe in saliva testing and hormones are very tricky. To answer your question, I can tell when I’m having an adrenal crisis, it now happens more often and I’m still looking for the right doctor to treat secondary addisions. I use the cream on the inner thigh or inside of the arms and when I’m not doing so well, I don’t really measure out the teaspoons but I can tell you this did save me a trip to the ER, I would definitetly recommend a doctor, but listening to your body is so important, like right now I don’t want to turn my adrenals off so I’m not using the cream daily only when by body just shuts down. I use just over the counter Exederm or generic hydrocortisone cream but also found keeping iron levels up helps the adrenals (Ferritin level, very important) and also to mention, overseas they sell panthenol cream, you can find it on ebay, I want to try this to see if it is similar to hyrdocortisone cream b/c pantothenic acid (panthenol) is the precusor for all adrenal functions. Hope this helps a little. This website has helped me so much.

  7. Lily

    Ps. I can see from previous comments, 1/4tsp of 1% HC cream equals 10mg. Where on the body do you apply ? What’s a good starting dose (I have 3 lows and 1 high) and how often ? I have been using ACE for several months and feel I need more

    • Janie Bowthorpe

      Let me qualify something here for anyone reading this: we have learned over the years that you have to be careful, even with cream. For one, without saliva testing, you don’t know where exactly you are having low cortisol. Symptoms of high can be similar to symptoms of low, as a lot of folks have reported and found out the hard way. Second, treating low cortisol needs precision in the amounts (more than 10 mg for women, for example, shuts down the ACTH too much). We also seek to follow the circadian rhythm. Third, the cream has a high risk of thinning the skin, so it’s crucial to change the area around where you apply.

      Finally, purple moon said she had a low ACTH. A lot of us as thyroid patients do not have a low ACTH, yet cortisol issues. A low ACTH implies a pituitary problem. So yes, she might benefit. But for the rest of us…if you do try it…understand the risks and potential problems. It’s why we came to the conclusion that cream works best, with the least risk, just for stress-dosing, not for treating low cortisol.

      The last chapter in the STTM II book does a bang-up job explaining why we, as thyroid patients, get low cortisol (and not from hypopituitary or Addisons). It’s written by a doctor!

      • Janie Bowthorpe

        Also want to add: purple moon seemed to need it if she was having a crisis! A crisis may need it. But for most thyroid patients with proven low cortisol, using solely cream to treat that has problems…whereas stress dosing can work well with cream.

  8. Purple Moon

    I see this post is older, but had to respond. I have experience using Hydrocortisone cream for adrenals. I have very low ACTH and cortisol level yet doctors deem me within range (means nothing) I have Reverse T3 (symptom of low adrenals) and my thyroid numbers are within range but doctors all say my numbers make no sense. Well I got really sick in my 20s, which drained my adrenals, now in my 40s I have had adrenal crisis (where you pass out or collapse) cannot feel anything and you feel a scary feeling at your core…”Adrenal Crisis”….n/a to get to the ER and try to explain to doctors what’s wrong with me, I remembered the Hydrocortisone cream and after using every 30 minutes for a few hours…it literally saved my life. Please anyone knowing how this feels……Use the Hydrocortisone cream.

    • Lily

      Every 30 minutes – great. Where do you apply it please ? And do you buy the cream over the counter at a pharmacy. Any guidance you can provide on when, where, how frequently to use would be greatly appreciated. Thank you.

  9. LL

    I feel that adrenal fatigue is hopeless although i keep pressing forward. Both ACE and HC give me heart palps even dosed by saliva test. It’s misery with or without it

  10. Liz Strong

    I’m confused about adrenal fatigue and cortisol issues. I have no doubt I have adrenal fatigue, however, about two hours after I go to bed, I sometimes wake up feeling overheated and with strange mild tremors from my chest to my thighs. I kick covers off for about 20 minutes, then I’m back to normal. I’m usually cold, sometimes waking up before morning needing another blanket.

  11. Misty vsnfoeken

    You must be very careful with hydrocortisone. U absolutely need labs to see where u are at via labs & cortisol levels. If u take to much u could have very serious health issues. Cortisol is known as a ‘death’ hormone for good reason.

    • Janie Bowthorpe

      Misty, nothing on STTM is about being careless with HC nor avoiding labs nor using HC towards death. lol. It’s all about patient knowledge and wisdom based on research and good information and what has worked for them in the safest way.

  12. Xandyland

    I have been using Isocort for about 6 months now for insomnia issues (my circadian rhythm is reversed). Last summer I was having similar symptoms to what is written in the above article. My Naturpath Rx’d SELEGILINE and it has been a freaking miracle! Apparently many of the over the top symptoms I had attributed to adrenal fatigue were actually depression and have disappeared since taking Selegiline. It was approved by the FDA for Parkinson’s patients, but the unexpected side effect was a “prozac-like” effect without the nasty side effects. I get it through a compounding pet pharmacy and a 3 month supply is only $28! I still think Isocort is a fine product (tho suspiciously unavailable at the moment?!), but wanted to post my success story using Selegiline in case it might apply to someone else out there.

  13. Kim

    Was there ever an answer to this q about the HC cream??

    (From Janie: Obviously not, since there are no more comments. lol. Seriously, 1/4 tsp cream equals roughly 10 mg cortisol, so if one were sensitive to oral HC, this is an alternative to discuss with your doctor.

  14. suffering

    I read online somewhere (some site about adrenal insufficiency) that you can use OTC 1% Hydrocortisone cream on your body in divided doses to make a physiological dose of 20 mg. However, I can no longer find that site and don’t know how much to use per dose (1/2 teaspoon, etc.?) I was wondering if anyone on this site does this? I want to get my adrenals in order before going on Armour. (My doc won’t prescribe Cortef)


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